The role of culture and faith healers in the treatment of mood disorders in rural versus urban areas in United Arab EmiratesKhalid S Sherra, Mohamed Shahda, Dalia M KhalilMay-August 2017, 38(2):79-89DOI:10.4103/1110-1105.209678

Background
Culture plays a major role in healthcare delivery. The majority of mentally ill patients prefer to attend nonmedical practitioners such as traditional healers. Practical clinical application of the research in cultural competency can enable physicians to decide whether folk traditional healing practices are harmful or benign. Like other cultures, the Arab culture transmits a number of beliefs, which are locally shared, although considered unlikely or even objectively disprovable by others outside the culture.
Aim
In this paper, we examine the view of mood disorders as seen by the patients and the role of faith healers in the treatment of such disorders with regard to urban versus rural areas.
Patients and methods
We assessed 416 United Arab Emirates national patients with Bipolar Affective Disorder (BAD) (279 urban and 137 rural) after confirmation of diagnosis with Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revised. These patients underwent Mini International Neuropsychiatric Interview, Help-Seeking Pattern, and Experience Questionnaire, which stressed on the attitude of the patient toward psychiatric illness, belief in healer management, line and result of traditional management, and the frequency of seeking traditional healers.
Results
The current study showed that about 60% of patients of both populations had visited faith healers before seeking medical services. Rural population usually shows no commitment to treatment and resorts to traditional therapy more often compared with the urban population (24 vs. 17.5% and 33.7 vs. 19%, respectively). Rural patients were more credulous toward faith management compared with urban patients (35.1 and 18.4%, respectively), whereas a merge of the two beliefs, psychiatric and faith management, was more common in the urban population than in the rural population (31.6% compared with 9.6%, respectively). An overall 39.5% of the families of urban cases and 9.6% of the families of rural cases considered mental illness a real disease as any other organic disease. In faith healing, different diagnoses, which included touch, evil eye, witchcraft, and jinn possession, were evenly distributed among patients with varying percentages among rural and urban populations.
Conclusion
This study shows that the majority of patients suffering from mental illness, especially in rural populations, prefer to approach faith healers first, which may delay entry to psychiatric care and thereby negatively impact the prognosis of BAD. Therefore, we should improve the orientation of the general practitioners (GPs) and broaden the destigmatization program about psychiatric disorders, especially mood disorders. This highlights the importance of mental health education, developing a positive collaborative relationship with traditional healers, and highlighting the role of cultural beliefs in both the evaluation and the management of mental disorders.

Objectives
To show the correlation between items of Callous Unemotional Inventory (CUI) and Conduct Disorder and to assess correlation between salivary cortisol and Conduct Disorder.
Background
Emerging evidence suggests that low levels of cortisol may act as a biological marker for the Callous Unemotional traits (CU Traits) subgroup of Conduct Disorder.
Materials and methods
The current study tested the presence of items of Callous Unemotional Inventory (CUI) and the salivary cortisol level among group of patients with Conduct Disorder (Forty patients from 12 to 16 years old, diagnosed according to criteria of DSM IV and recruited from Kasr El Aini Psychiatric hospital) and group of control (Forty healthy volunteers). Both groups were subjected to Callous Unemotional traits Inventory and salivary cortisol level was assessed using ELISA.
Results
Patient group showed high levels of CU traits compared to control group. Patient group showed significant difference in salivary cortisol level (mean is 3.188 ±1.1108) compared to control group (mean is 5.01±1.846).This study found correlation between Callous traits and severity of Conduct Disorder.
Conclusion
The current findings build upon recent research in suggesting that low cortisol level may be a biological marker for patients with Conduct Disorder and high levels of CU traits.

Background
Irritable bowel syndrome (IBS) is a highly prevalent functional gastrointestinal disorder. Psychiatric disorders are common among IBS patients and it differs among different cultures. This study was carried out to assess sociodemographic variables and determine the magnitude of anxiety–depressive disorders among IBS patients for proper management.
Patients and methods
In a cross-sectional study, 73 IBS patients were diagnosed (using the criteria of Rome III) from among 400 serial patents attending the gastroenterology clinic at Islamic University Medical Centre (IUMC), Al-Medina Almounawarrha, KSA, in the period from January to December 2015 and were assessed for sociodemographic variables and anxiety–depressive disorders by psychometric tests, the Arabic version of ‘Taylor Manifest Anxiety Scale’ and ‘Beck Depression Inventory Scale’, compared with 73 non-IBS patients.
Results
Of 400 patients who participated in this study, 73 (18.25%) were diagnosed with IBS and 327 (81.75%) were non-IBS patients. In terms of sociodemographic data, IBS patients were matched with non-IBS patients for age, race (different races from different countries), and living condition. Female sex was predominant as regard sex, family history of IBS, emotional stress and traveler’s diarrhea with statistically significant difference. These variables were statistically significant in our study. In terms of lifestyle factors, both groups were matched for smoking and caffeine intake, but IBS patients experienced food hypersensitivity with a tendency to have normal body weight, and to have poor physical exercise and poor quality of sleep with a statistically significant difference compared with the non-IBS patients. For psychometric tests, 46 (63%) out of 73 patients were diagnosed with anxiety–depressive disorders; 16 (22%) had pure anxiety disorders, 18 (24.6%) had depressive disorders, and 12 (26.4%) had comorbid anxiety–depressive disorders.
Conclusion
The high prevalence of anxiety–depressive disorders among IBS patients led us to perform a psychiatric assessment as an important part of the management plan for IBS patients.

Background
A strong association is believed to exist between stressful life events and development of depressive disorders. Childhood adverse experiences contribute to a person’s vulnerability to such disorders. The complex interplay between these variables needs further investigation.
Objectives
The objective of the present study was to clarify the impact of child abuse and recent stressful life events on patients with depressive disorders.
Patients and methods
A total of 75 patients with depressive disorders not having a comorbid mental illness were studied using the Social Readjustment Rating Scale of Holmes and Rahe and the Childhood Trauma Questionnaire.
Results
The mean age of our patients was 34.96±12.32 years, 69.3% of them were females, and the duration of illness ranged from 2 to 288 weeks with a mean of 30.94±54.61; 36% of the sample had severe depression. There was a statistically significant relationship between urban residence and magnitude of stress (P=0.049); married patients suffered less severe depression compared with unmarried ones (P=0.02). A positive and significant correlation was found between magnitude of stress and severity of depression (P≤0.001).
Duration of depressive illness was positively and significantly correlated with the raw score of Social Readjustment Rating Scale and with the severity of emotional neglect as measured by the Childhood Trauma Questionnaire (P=0.02 and 0.04, respectively).
Conclusion
The development of depression in adulthood is significantly associated with past exposure to child abuse and stressful life events. Childhood history of emotional neglect and magnitude of preonset stress may be contributing factors to the duration of depressive illness.

Backgrounds
Duration of hospitalization (DOH) and length of stay in psychiatric hospitals are important factors affecting psychiatric patients and their families, in addition to their impact on the healthcare system policy and budget.
Objectives
The aims of this study were to identify the sociodemographic and clinical factors implicated in determining DOH and to study the effect of global functioning and insight on length of stay in psychiatric hospitals.
Patients and methods
A total of 129 inpatients diagnosed with affective and nonaffective psychoses were recruited from Minia Psychiatry Hospital. Data regarding their demographic and clinical manifestations were collected, including previous and current admissions. Their severity of illness was assessed with Positive and Negative Syndrome Scale, the level of initial functioning was evaluated by Clinical Global Impression Scale, and the details of their insight were measured by Scale to assess Unawareness of Mental Disorder.
Results
Female participants tended to have longer DOH than males, whereas males tended to have higher number of previous hospitalizations than females. Divorced and single patients had significantly longer DOH than married patients. DOH of current admission was found to increase with increasing severity of mental illness, decreased awareness of mental disorders, deceased awareness of achieved effects of medications, and decreased awareness of social consequences of mental illness. Number of hospitalizations was found to significantly increase with younger age at onset, longer duration of illness, higher number of previous episodes, whereas it was found to decrease with higher total number of received electroconvulsive therapies.
Conclusion
Sex and marital status have an effect on DOH. Increased severity of mental illness and disturbance of insight increase DOH and so does the initial decrease in global functioning.

Background
Child abuse − a form of family violence − is one of the major public health issues with far-reaching effects and costs and have many implications on health policy and prevention strategies.
Objective
The aim of the study was to assess risk factors of child physical abuse among school-aged children in the child’s background and family characteristics and to estimate its psychiatric sequelae.
Patients and methods
The study was conducted in Maternity and Children Hospital, Al Medina (Al Monawara), Kingdom of Saudi Arabia, on school-aged children referred from the committee protection program from September 2012 to April 2015 using such some psychometric tests as the Child Maltreatment Questionnaire, the Mini International Neuropsychiatric Interview for children and adolescents (for major depressive episodes), Revised Behavior Problem Checklist, and Copper Smith Self-Esteem Inventory.
Results
Out of 186 students (age range between 12 and 16 years) 49.4% were the youngest children, mainly boys (58%), 94% had good health, 70% were from large-sized families, and 51% of whose mothers and 54% of fathers were illiterate, and all these variables showed a significant difference in both mild/moderate and severe child abuse. There were significant associations between physical abuse and low self-esteem, major depressive episode, conduct disorder, anxiety withdrawal, attention deficit hyperactivity disorder, and socialized aggression, mainly with severe physical abuse.
Conclusion
Physical abuse is found in a significant proportion of children, mostly living in large-sized families, of illiterate unemployed parents. Furthermore, physical abuse is commonly associated with low self-esteem, major depression episodes, conduct disorder, attention deficit hyperactivity disorder, and socialized aggression.

Background
Self-help was found to be beneficial in terms of reduced binge eating, improved abnormal eating attitudes, and higher abstinence rates. They are typically brief and less costly compared with other therapies.
Objectives
The present study was designed to assess the outcome of guided self-help group therapy on female patients with binge eating disorder (BED).
Patients and methods
In the present experimental clinical trial, 27 female patients between 18 and 45 years of age diagnosed with BED were enrolled in guided self-help group therapy once weekly for 12 consecutive weeks. Prepsychometric and postpsychometric assessment was carried out to measure eating pathology, frequency of binge eating episodes, and self-esteem using Eating Disorder Examination, Symptom Checklist (SCL90-R), and Rosenberg’s self-Esteem Scale in addition to BMI.
Results
Patients showed a significant decrease in frequency of binge eating episodes (P=0.000), less over concern of body weight and shape, less BMI (P=0.000), and less psychological distress with no difference in self-esteem.
Conclusion
Guided self-help therapy is effective in reducing the severity of BED.

Background
It has been recently shown that electroencephalogram (EEG) paroxysmal abnormalities are frequently recorded in patients with autism despite the absence of seizures.
Objective
On the basis of the increasing evidence of EEG abnormalities in autism, the aim of this study was to detect the EEG abnormalities in relation to the degree of severity of autism.
Patients and methods
EEG was measured in 40 autistic children aged 2–12 years, in comparison with 40 typically developing matched children. The severity of autism was assessed using the Childhood Autism Rating Scale.
Results
We found that 50% of the autistic children had abnormal EEG findings. There was a statistically significant relation between the EEG abnormalities and the severity of autism. Moreover, there was a statistically significant relation between the site of the wave abnormalities and the severity of autism.
Conclusion
Our study suggests that the use of neurological investigative techniques such as EEG be considered routinely during the evaluation of autistic children.

Depression in caregivers of patients having dementia before and after a psychoeducational course, CairoSamah H RabeiMay-August 2017, 38(2):65-69DOI:10.4103/1110-1105.209683

Background
The efficacy and effectiveness of family psychoeducation as an evidence-based practice have been established. Systematized use of family psychoeducation in routine clinical practice is alarmingly limited worldwide and in Egypt.
Aim
This study aimed to assess the degree of depression in caregivers of patients having dementia before and after an intensive psychoeducational course with skill-training tailored and modified to suit their emotional and behavioral needs.
Participants and methods
Fifty caregivers of dementia patients in the Geriatrics Department Outpatient Clinic, Ain Shams University, Cairo, were assessed after written informed consent had been obtained from them. A score equal to or below 24/30 on the mini-mental state examination (MMSE) and International Classification of Disease, version 10, criteria were used to diagnose dementia patients. The activity of daily living (ADL) scale was also used and scored. The caregivers were assessed before and after a psychoeducational course using Beck’s depression inventory II. Their occupational level was described as per the family socioeconomic scale. Statistics were analyzed using SPSS (version 16).
Results
Caregivers experienced a reduction in Beck’s depression inventory II score. The average decrease was 3.6 points after psychoeducation.
There were correlations and associations between decrease in depression scores after psychoeducation and age and occupation of caregivers, higher MMSE scores, and lower ADL impairment in patients with dementia.
Conclusion
Psychoeducation improves depression scores more in young working caregivers of patients with dementia with higher MMSE and lower ADL impairment.

Impact of familial risk factors on the severity of addiction in a sample of Egyptian adolescentsShereen A El-Awady, Eman A Elsheshtawy, Wafaa A Elbahaey, Osama A ElboraieMay-August 2017, 38(2):70-78DOI:10.4103/1110-1105.209677

Background
The 20th century ended with the conviction that drug abuse was a global problem, and thus global solutions were required. Adolescence represents a critical time to prevent alcohol and other drug use. Early initiation and regular use is often associated with negative consequences. Research on adolescents focuses increasingly on features of the family in predicting and preventing substance use, such as parenting style, parental monitoring, and parental substance use. Although there is an increasingly alarming phenomenon of drug abuse demonstrated in the Egyptian community, there has been no study that estimated the prevalence and risk factors of substance abuse in adolescents in Egypt recently.
Aim of the work
The current study aimed at exploring the effect of various familial risk factors on the development and severity of substance use in adolescent Egyptians.
Participants and methods
The current study included two groups: the patient group, which included 100 adolescents (92 male and eight female) from Mansoura, Egypt, between 10 and 19 years of age who were diagnosed as being substance abusers or substance dependants according to the DSM-IV-TR criteria; and the control group, which included 100 (86 male and 14 female) age and sex matched participants with no current psychiatric or neurological disorders. Tools of assessment used were as follows: Mini International Neuropsychiatric Interview for children and adolescents (MINI KID), the Teen Addiction Severity Index (T-ASI) scale, and a scale for measuring family socioeconomic status for health research in Egypt. Familial assessment was carried out with Parental Monitoring Questionnaire and parenting style questionnaire.
Results
The incidence of substance use was higher in male (92%) than in female (8%) adolescents. The most commonly abused substances were tramadol (97%), followed by cannabis (94%) and sedatives and hypnotics (38%), and the least commonly abused substance was anticholinergic (12%). The majority of the studied addicts were abusing more than one drug (92%). The results of the study indicated a highly significant difference between substance users and controls on all familial risk variables.
Conclusion
The substance use disorders are a major health problem among youth, and it is more prevalent in male sex in Egyptian population. Tramadol dependency is at the top of all substances abused in Egypt, followed by polysubstances. The findings highlight how family influences subsequent adolescent substance use.